Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition

2 yo female presented to ER with fever and vomiting for 1 week. Chest x-ray was ordered with an incidental finding of a button battery
found to be lodged in the thoracic inlet. The battery was estimated to be lodged in place for approximately 5-7 days. ENT was consulted
and surgically removed the battery. Significant mucosal erosion was noted. The child was admitted and an attempt at a barium swallow
was made but the child could not swallow the needed contrast. The exam did show no evidence of esophageal perforation and the baby
was discharged. The child returned on August 19, 2012 with fever. CXR was clear. Viral syndrome was diagnosed due to fever and
cough. She was discharged. The child returned to the ER that night as the child was crying and had neck pain. Lumbar puncture and
several labs were performed. No neck pain on flexion was noted. The child was discharged with a diagnosis of viral syndrome. The child
returned to the ER on August 21, 2012 with continued fever. Her respirations were unlabored and she had clear lung sounds. She was
alert, playful and in no acute distress. Neck was supple. Further testing included throat culture, UA and x-rays, all of which were
negative. On August 22, 2012, the child returned via EMS unconscious and vomiting blood resulting from late onset of complications
from the battery ingestion. EGD and other tests were completed. Diagnoses showed acute esophageal ulcer with perforation, gastric ulcer
with hemorrhage, hemorrhagic shock. Shortly after admission, the child coded and expired. Cause of death was exsanguination due to
erosion of the common carotid artery through a carotid esophageal fistula that had formed due to a chemical alkaline battery burn.

The child expired due to complications from button battery ingestion. Allegations included failure to consider the child's past history
noted in her medical records, failure to order imaging including CT of the neck and esophagus,